Scintimammography in the diagnosis of breast cancer

BACKGROUND: Mammography has a positive predictive value in the detection of breast cancer of 15% to 25%, Ten percent of patients with breast cancer present with normal mammograms; however, the false negative rate is increased in younger patients. The purpose of this study was to evaluate the effectiveness of Tc-99m Sestamibi imaging in the diagnosis of breast disease. METHODS: Images were collected on 147 women, Patients were evaluated with a combination of physical examination, sonography, and mammography. Each patient received 20 millicuries of Tc-99m Sestamibi intravenously, Anterior and lateral images were obtained, the latter with the patient prone and the breast in the dependent position. RESULTS: One hundred seven patients showed no enhancement (negative scan), Seven of these patients were found at biopsy to have carcinoma, Five had ductal carcinoma in-situ (DCIS) with no associated mass, 1 had an incidental 3 mm focus of invasive ductal carcinoma (IDC), and 1 had a 5-cm cystic lesion with IDC, Forty-one patients showed focal enhancement on their scans (positive scan), Thirty-six were found to have either invasive or in-situ cancer. Four of the 5 patients with benign findings had sclerosing adenosis, The positive and negative predictive values for scintimammography in this group of patients were 88% and 93%, respectively, The sensitivity and specificity were 84% and 95%, respectively. CONCLUSIONS: We conclude that scintimammography is a highly specific test that deserves study as a modality to further refine the indications for breast surgery. (C) 1996 by Excerpta Medica, Inc.